Health Needs of Ashram Schools in Rural Wardha

Objective: To assess the health needs for health promoting Ashram schools in rural Wardha. Methods: It was a cross sectional study undertaken in 10 Ashram schools, using qualitative (SWOT analysis, Transect walks and Semi-structured interviews of teachers) and quantitative (Survey) methods. Hemoglobin examination of all children was done by using WHO hemoglobin color scale. Anthropometric measurements such as height and weight of each child were obtained. Physical activity score for each child was calculated. The manual content analysis of qualitative data was done and the quantitative data was entered and analyzed using Epi_info (version 6.04d) software package. Results: Out of 1287 children examined, 724 (56.3%) were boys and 563 (43.7%) were girls. About 576 (44.8%), 213 (16.6%), 760 (59.1%) children had untrimmed nails, dirty clothes and unclean teeth respectively. More girls had (31.6%) lice infestation than boys (18.2%). Eighty six (6.7%), 75 (5.8%) and 110 (8.6%) children had scabies, fungal infection and multiple boils on their skin respectively and 158 (12.3%), 136 (10.6%) and 66 (18.3%) children had dental caries, wax in ears and worm infestation respectively. Notably, 988 (76.8%) children had iron deficiency anemia which was significantly more among girls (81.9%) than boys (72.8%). About 506 (39.3%) children consumed any tobacco product in last one month. About 746 (57.9%) children were classified to have sedentary physical activity. Among 774 children (>12 years), 183 (23.6%) and 34 (4.4%) children felt lonely ‘sometime’ and ‘most of the times’ respectively. About 398 (94.3%) boys and 342 (97.2%) girls did not know the modes of transmission of HIV/AIDS. Conclusions: In conclusion, there was high prevalence of risk factors for both communicable and non-communicable diseases in Ashram school environment. This dictates the urgent need for teacher driven, needs based and school based intervention that can screen and identify potentially preventable health conditions among underprivileged Ashram school children

An Approach to Monitor and Initiate Community Led Actions for Antenatal Care in Rural India – A Pilot Study

Background and Objective: Utilization of antenatal care in rural India is far from universal. It requires monitoring and identification of specific needs at field level for timely corrective actions. To pilot test the triangulation of rapid quantitative (Lot Quality Assurance Sampling) and qualitative (Focus Group Discussion) monitoring tools for ensuring antenatal care in a community based program. Methods: The present study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Centre (KRHTC), Anji, which is also a field practice area of Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. The monthly monitoring and action system of the study was based on the rapid quantitative monitoring tool (Lot Quality Assurance Sampling, LQAS)to find out poor performing supervision areas and overall antenatal service coverage and the qualitative methods (Focus group discussions (FGDs), and free listing) for exploring ongoing operational constraints in the processes for timely decision making at program and community level. A trained program supervisor paid house visit to 95 randomly selected pregnant women from 5 supervision areas by using pre-designed and pre-tested questionnaire. For poor performing indicators, semi structured FGDs and free listing exercise were undertaken to identify unmet service needs and reasons for its poor performance. Results: Registration of pregnancy within 12 weeks improved from 22.8% to 29.6%. The consumption of 100 or more IFA tablets during pregnancy significantly improved from 6.3% to 17.3%. There was significant improvement in awareness among pregnant women regarding danger signs and symptoms during pregnancy. Over three months period, the overall antenatal registration improved from 253 (67%) to 327 (86.7%). Conclusion: The present field based monitoring and action approach constructively identified the reasons for failures and directed specific collective actions to achieve the targets

Effect of use of socially marketed faucet fitted earthen vessel/sodium hypochlorite solution on diarrhea prevention at household level in rural India

Objective: To evaluate the effect of socially marketed faucet fitted to earthen vessel / sodium hypochlorite solution on diarrhea prevention at rural household level as a social intervention for diarrhea prevention under ‘Community Led Initiatives for Child Survival (CLICS) program. Methods: Unmatched case-control study was carried out in 10 villages of Primary Health Centre, Anji, located in rural central India. During the study period, 144 households used either faucet fitted earthen vessel to store drinking water or used sodium hypochlorite solution (SH) for keeping drinking water safe. These served as case households for the present study. 213 neighborhood control households from same locality who used neither of the methods were also selected. Results: Odds ratio for households who used faucets fitted to earthen vessel was 0.49 (95% CI= 0.25 – 0.95). Odds ratio for households who used sodium hypochlorite solution was 0.55 (95% CI= 0.31 – 0.98). Use of these methods by the community, would prevent about 27 percent and 22 percent cases of the diarrhea (Population attributable risk proportion = 0.25 by faucets fitted to earthen vessels and 0.22 by use of sodium hypochlorite solution) respectively. Conclusion: To ensure safe drinking water at household level, the effective and cheap methods like fitting faucet to traditionally used earthen vessel and/or use of sodium hypochlorite solution must be promoted through community participation at household level for cost and culture sensitive rural people in Indi

Formative exploration of students’ perception about Community Medicine teaching at Mahatma Gandhi Institute of Medical Sciences, Sewagram, India

Objective: The objectives of the present formative research were to explore the medical undergraduates’ study problems and their perceptions about various teaching approaches in currently practiced teaching curriculum of Community Medicine. Material and Methods: The present formative research was undertaken at Dr. Sushila Nayar School of Public Health incorporating Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram. The respondents were 17 (26.5%) conveniently selected final year exam appearing medical undergraduates from 2004 regular batch of 64 students. A triangulation of qualitative research methods like free listing, pile sort exercise and a Focus Group Discussion (FGD) were used. A two dimensional scaling and hierarchical cluster analysis was completed with the pile sort data. The data was analyzed by using software Anthropac 4.98.1/X software. Results: The medical undergraduates could understand the topics like Integrated Management of Neonatal and Childhood (IMNCI), Primary Health Care (PHC), cold chain system for vaccines, immunization and health education, dietary survey and cluster survey method taught in the community based camp approaches. Students found it difficult to comprehend the core of subject from the scattered lecture series over a long teaching period, especially using lengthy over head projector/liquid crystal display presentations. The major problems encountered in studying the subject of Community Medicine were difficulty in understanding the concepts of biostatistics, confusions due to apparently similar text in National Health Programs and difficulty to recall disease statistics due to vast syllabus. Conclusions: Students perceived the community based camp approach of teaching as a best method to understand the subject, which is an integration of task oriented assignments, integration of social sciences within medical domain and active community involvement. Hence, the community based camp approach can be scaled up as a best Community Medicine teaching approach. The active learning methods could be used to improve the lectures and the clinics which should be more concentrated in final year of teachin

Application of Qualitative Methods in Health Research: An Overview

Qualitative research is type of formative research that includes specialized techniques for obtaining in-depth responses about what people think and how they feel. It is seen as the research that seeks answer to the questions in the real world. Qualitative researchers gather what they see, hear, read from people and places, from events and activities, with the purpose to learn about the community and to generate new understanding that can be used by the social world. Qualitative research have often been conducted to answer the question “why” rather than “what”. A purpose of qualitative research is the construction of new understanding. Here, we present an overview of application of qualitative methods in health research. We have discussed here the different types of qualitative methods and how we and others have used them in different settings/scenarios; sample size and sampling techniques; analysis of qualitative data; validity in qualitative research; and ethical issues

A community based cross sectional study on feasibility of lay interviewers in ascertaining causes of adult deaths by using verbal autopsy in rural Wardha

Background & objectives: 1) To study the causes of adult (15 years and above) deaths using verbal autopsy (VA) and its socio-demographic characteristics. 2) To study the feasibility of use of the lay interviewer to ascertain causes of adult death using verbal autopsy and a simple algorithm. Methods: The present study was done in Wardha district, Maharashtra, India. Taking into account feasibility, out of 23 villages of Primary Health Centre, Anji, 15 villages were chosen having total population of 14,590. Out of 273 estimated adult deaths during the study period, 209 (77%) could be traced by house to house visit and a lay interviewer, interviewed the close caretakers of the deceased. Both lay interviewer and a physician individually derived their diagnosis using verbal autopsy report and a simplified algorithm. The data was entered and analyzed by using Epi_info 6.04. The inter-observer reliability between the lay interviewer and a physician for each possible diagnosis was assessed by using the Kappa statistics. Considering the diagnosis made by a physician as a gold standard, the diagnostic and predictive accuracy for each diagnosis made by the lay interviewer was calculated. Results: The communicable diseases accounted for 52 percent of the adult deaths while non-communicable for 32 percent and injuries for nine percent deaths. The overall agreement between the lay interviewer and a physician for communicable diseases was found to be good (k = 0.65 + 0.06) and for non-communicable diseases it was found to be excellent (k = 0.80 + 0.06). The lay interviewer using VA performed adequately for individual conditions of public health importance like acute febrile illness, diarrheal diseases, tuberculosis and injuries. Interpretation & conclusions: The present study has been successful to demonstrate feasibility of use of the lay interviewer to provide useful information on population-level estimation of broad causes of adult deaths and its socio-demographic characteristics that are reasonably reliable. The study suggests the possible utility of the method for rural India, where the majority of deaths occur at home. Further research work on development of sensitive and specific yet simple algorithms for lay interviewers to ascertain causes of adult deaths is required

An approach to hygiene education among rural Indian school going children

Objectives: To find out the prevalence of intestinal parasites and its epidemiological correlates among rural Indian school going (6-14 years) children and to study the effect of focused, need based child to child hygiene education on personal hygiene of school children. Materials and Methods: In September 2007, the present participatory action research was undertaken at a feasibly selected village Dhotra (Kasar) in Wardha district of central India. A triangulated research design of quantitative (survey) and qualitative (transect walk & pile sorting) methods was used for the needs assessment before initiating formal hygiene education. Out of enlisted 172 children, data of 118 children with complete information was used for final analysis. The quantitative and qualitative data was entered and analyzed using the Epi Info 6.04 software and Anthropac 4.98.1/X software package respectively. School based participatory life skills based child to child hygiene education was undertaken for message dissemination and behavior change. The effect of this hygiene education on identified key behaviors was assessed after one month Results: Out of the 118 (50 male and 68 female) subjects examined 21 (17.8%, 95%CI, 11.4 – 25.9%) had intestinal parasite infection. The prevalence of intestinal parasitic infection was significantly high among children having dirty untrimmed nails (47.4%, 95%CI, 30.9 – 64.1%) followed by those having poor hand washing practices (37.2%, 95%CI, 22.9 – 53.2%). One month after hygiene education, the proportion of children having practice of hand washing with soap after defecation significantly improved from 63.6 % to 78%. The proportion of clean and cut nails also improved from 67.8% to 80 % (p<0.05). Conclusions: The need based, focused, life skills based child to child hygiene education was effective for behavior change. An integrated approach of drug treatment and focused participatory hygiene education is required to control parasite load among rural Indian school going children

Reports of Child Abuse in India from Scientific Journals and Newspapers - An Exploratory Study

Background: Child abuse is a state of emotional, physical, economic and sexual maltreatment meted out to a person below the age of eighteen and is a globally prevalent phenomenon. A total of 33,098 cases of crimes against children were reported in India during 2011 as compared to 26,694 cases during 2010, suggesting a recent increase of 24 percent. Objectives: To explore the contents of the published articles/reports on child abuse in India from scientific journals and newspapers identifying areas and gaps for further research and program development. Material and Methods: Published articles in scientific journals during the years 2007-2012 with free access and online versions of English newspapers (2007-2012) in India were searched using the search engines such as ‘PubMed’ and ‘Google’. The key words used were ‘child abuse in (on, about) India. First two researchers independently reviewed the content of articles/newspaper reports and decided the categories emerging from the articles and reports. Later on, the quantification of these categories was done by identifying the number of times it was reported in the reports. Results: The nature and extent of reporting child abuse in scientific journal is different from that of newspapers. In Journals, our search provided us with 9 articles, of which prevalence studies were predominant (4) followed by case reports (3) and Knowledge, Attitude, Practice studies (2). The studies were mostly conducted in the hospital setting. We obtained 38 reports from newspapers. Child abuse was found more among girls. Among type of abuse, sexual abuse was more common (84.2%). About 52.6% of the abusers were members known to the victim. The maximum cases were reported from West India especially in Goa, followed by South region. Most reports reported legal action on accused. Little was reported on what happened to a victim, indicators of abuse and settings of the abuse. The motives and consequences of the abuses were not mentioned explicitly. Conclusions: The articles were more focused on prevalence of child abuse in hospital settings. As per newspaper reports, female child abuse (sexual abuse) by a known person to family was reported more. It was found more in West part of India. Recommendations: More research/reporting is required to study the extent of problem in different settings of India, settings of abuse, quality of life of victims, parental/community education on indicators of abuse and development of support program to victim

Status of Growth Monitoring in Anganwadi Centres of a Primary Health Centre, Thirubhuvanai, Puducherry

Purpose: To assess the status of growth monitoring activities and difficulties faced by anganwadi workers (AWWs) at the anganwadi centres (AWCs). Methodology: A survey was conducted among AWWs under a rural Primary Health Centre. Structured observations on weight measurement were made using a check list. Secondary data on record keeping and maintenance was collected. Findings: Study participants (n=20) had a 24 (± 10.25) years of experience in Integrated Child Development Services and underwent training once in two years. For advising mothers of malnourished children, deworming and immunization was not mentioned by majority AWWs. In AWCs, children less than 6 month were weighed on bathroom scale and not by Salter’s scale. Unclothing the child before weighing was practiced by only 10% AWWs. Nonfunctional weighing machine was the major problem reported by AWWs. Conclusion: There were gaps in the growth monitoring activities in AWCs of a PHC, Thirubhuvanai which needs to be tackled

An Approach of Initiating Geriatric Screening OPD at the Rural Health Training Centre of SMVMCH, Pondicherry

Objectives: To study the common chronic health problems among the elderly patients attending in recently initiated geriatric screening OPD at the RHTC. Material and Methods: Since one year, screening OPD has been started at RHTC of SMVMCH, for old patients (>60 years), twice a week. A team of trained medical interns, a post-graduate, a faculty in Community Medicine and a counselor screen and counsel the elderly patients for common medical and mental health problems. The screening tool is structured and has been adopted for patients of geriatric OPD at RHTC. The screening tool consist of General Health Questionnaire (GHQ-5), Psychosis screening, Alzheimer’s disease (AD8) questionnaire and checklist of common medical conditions. Patients were screened for early detection of health problems followed by counseling them/their caregivers and referral to specialty OPD for further care. Results: Total 512 elderly patients were screened over 4 months period from the start of geriatric OPD. Out of them, 276 (54%) and 117 (23%) were between the age group of 60-65 years and 66-70 years respectively. Among them 387 (75%) were below poverty line and 68 (13.3%) were having some kind of health insurance. GHQ score indicates that 255 (50%) patients had a score more than one and it was significantly higher among females compared to males. About 76 (16.8%) elderly had a score of > 1 for psychosis, out of which only 12 (14%) were referred to the higher centre. AD8 score shows 204 (40%) patients attended the clinic having a score more than 1 and it is significantly higher among females compared to males. Counseling for caregivers was given only in 13 (6%) of the patients with high AD8 score. Common chronic conditions present among them were joint pains (310, 60%), visual disturbances (247, 48%), hearing difficulty (120, 23.4%) and hypertension (107, 21%). Conclusion: The proportion of people with AD8 score more than 1 is high and most common chronic condition seen is joint pain. The action component of the clinic such as referral of dementia patients, psychosis patients and counseling of their care-givers need to be strengthened